Healthcare Provider Details

I. General information

NPI: 1194985648
Provider Name (Legal Business Name): FMC CLINICS II PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 MEDICAL DR
AMARILLO TX
79106-4165
US

IV. Provider business mailing address

14 MEDICAL DR
AMARILLO TX
79106-4165
US

V. Phone/Fax

Practice location:
  • Phone: 806-358-8300
  • Fax: 806-358-8608
Mailing address:
  • Phone: 806-358-8300
  • Fax: 806-358-8608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTI KEELER
Title or Position: MANAGER
Credential:
Phone: 806-353-6400